Pediatric Acetaminophen (Tylenol) Dosing Chart
The standard dose of acetaminophen for children is 10-15 mg/kg per dose, given every 4-6 hours, with a maximum daily dose of 60 mg/kg per day or 5 doses in 24 hours. 1
Weight-Based Dosing (Preferred Method)
Weight-based dosing is more accurate than age-based dosing and should be used whenever the child's weight is known. 1, 2
Standard Dosing by Weight:
- 10-15 mg/kg per dose 1
- Dosing interval: Every 4-6 hours 1
- Maximum: 60 mg/kg per day (not to exceed 5 doses in 24 hours) 1
Specific Weight Ranges:
For children weighing 10.9-15.9 kg (2-3 years), the 15 mg/kg dose is more effective than 10 mg/kg, as pharmacokinetic modeling shows that 10 mg/kg may not reach therapeutic plasma concentrations (10-20 μg/mL) needed for antipyresis. 3
Age-Based Dosing (When Weight Unknown)
While weight-based dosing is preferred, age-based schedules can be used when weight is unavailable. 4, 5
Special Population: Infants Under 3 Months
- Dose: 15 mg/kg if weight is less than 10 kg 1
- Acetaminophen is the ONLY recommended analgesic for this age group 1
Route of Administration Considerations
Oral Syrup (Preferred):
- Oral syrup is absorbed more rapidly and provides more consistent response compared to rectal suppositories 1
- Rectal acetaminophen should be used cautiously due to erratic absorption 1
When to Consider Rectal Route:
Important caveat: Erratic absorption of rectal formulations means some children may receive inadequate analgesia while others risk accumulation with repeated dosing. 1
Critical Safety Limits
Never exceed these maximum doses to prevent hepatotoxicity: 1, 6
- 60 mg/kg per day
- 5 doses in 24 hours
- Single ingestions exceeding 10 times the recommended dose are potentially toxic 6
- Chronic exposures greater than 140 mg/kg/day for several days carry risk of serious liver toxicity 6
Clinical Pearls
Onset and Duration:
- Maximum temperature reduction occurs approximately 3 hours after administration 5
- Rapid onset of temperature reduction begins shortly after dosing 5
Fever Management:
- Acetaminophen improves comfort but does NOT prevent febrile seizures 1
- For children with history of febrile seizures, prophylactic acetaminophen at 15 mg/kg can be given every 4 hours for 24 hours to reduce fever-related discomfort 1
Post-Vaccination Fever:
- Can be given at time of vaccination and every 4 hours for 24 hours 1
Alternating with Ibuprofen (If Needed)
When alternating acetaminophen and ibuprofen: 1
- Give acetaminophen every 4-6 hours
- Give ibuprofen (10 mg/kg) every 6-8 hours
- Stagger timing so medications are given every 3-4 hours if both are needed
- Note: Ibuprofen is NOT recommended for infants under 6 months 1
Common Dosing Errors to Avoid
Up to 30% of febrile children receive inadequate acetaminophen dosages at home, primarily due to age-based rather than weight-based dosing. 3 Always calculate dose based on current weight when possible, as manufacturer's age-based recommendations may be inadequate for children at the upper end of weight ranges for their age. 3